Protecting babies before pregnancy
 Dr. Hogan
Hogan and colleagues want to identify the underlying social
factors that may affect a woman's
health status and her participation in health care before
her baby is even conceived. Health
status before pregnancy is thought to have a huge impact on
pregnancy outcomes and to be a
large determinant of disparities. They are using data
collected from women who participated in
the largest study in the United States to date that tested
how health care interventions before
pregnancy - called interconceptional health care - may reduce
women's risk of preterm birth.
So far, Hogan is finding that even when other known barriers
to care (childcare, transportation,
etc.) are addressed, several other factors affect women's
ability to access and participate in
interconceptional health care. Multiple burdens, racism,
lack of social power, unpredictable
social emergencies, and institutional rules that eliminate
the flexibility women require to adapt to emergent social challenges, are just
some of these factors. Defining these social factors and finding a way to
reduce them will improve preventive care and help reduce the risk of preterm
birth among this group of women.
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Maltreatment in childhood can affect health for life
 Dr. Hussey
Remarkably, Hussey's findings indicate that physically
assaulted and (particularly) neglected children are more likely to drink,
smoke, use marijuana and report poor health than peers not experiencing child
maltreatment. This is the first nationally representative longitudinal study to
link childhood maltreatment to poor health and use of unhealthy substances
later in life.
As health indicators in adolescence and early adulthood are
predictive of future chronic disease risk, Hussey is now extending his work to
include looking at other significant childhood factors that could affect
long-term health and plans to increase the length of time he follows people
into adulthood. The major objective of the next phase is to explore the
pathways linking early life exposures to racial disparities seen in chronic
disease risk. It is this work that will likely yield significant policy and
practice implications.
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Breastfeeding: best feeding for babies
In North Carolina, African American women are 30 percent
less likely to breastfeed their infants, even though studies have shown that
breastfeeding helps protect infants from many types of health problems. Tamar
Ringel-Kulka, MD, research assistant professor of maternal and child health, is
working to change that dynamic. Through community-based participatory research,
she leads an effort to promote breastfeeding among African American women in
Durham, N.C.
With the Community Health Coalition in Durham and other
community organizations, businesses and individuals, Ringel-Kulka has developed
the Durham Breastfeeding, Education and Support Team (BEST) Alliance, a group
aimed at increasing the rates of breastfeeding among African American women who
are pregnant or who have newborns.
The first step was to complete a comprehensive community
needs assessment examining breastfeeding. The assessment consisted of reviewing
data from focus groups with African American mothers, fathers and grandmothers,
and conducting interviews with community stakeholders. Ringel-Kulka's
assessment provided detailed information about the disparity in breastfeeding
in the Durham community, identified barriers that limit breastfeeding, and
identified potential strategies that may effectively increase breastfeeding.
The findings are being used to develop, implement and evaluate a pilot
breastfeeding promotion intervention tailored to the needs of the Durham
community.
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Behavioral health benefits for families engaged in the child welfare system
 Dr. Wells
Among Wells' initial findings:
Caseworkers devote comparable effort to obtaining a range of
health services for black and white children once they have identified need,
but are less likely to report black children as needing mental health services;
Youth engaged with child welfare agencies are more likely to
receive substance abuse treatment when their caseworkers had better cooperation
with schools, courts, and other agencies; and
When caseworkers had social work degrees, parents were more
likely to report receiving family counseling as well as mental health treatment
for themselves.
Partnering with child welfare agencies, Wells works to close
gaps and improve access to behavioral health care for families in the child
welfare system.
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Research 
